In certain circumstances health insurance claims can be a frustrating process and more so if there is no help from the healthcare provider.
Often people are left to fend for themselves while filing a health insurance claim for a medical procedure which occurs after hospitalization.
In such a situation cashless facility will not be provided by the hospital or nursing home.
The expenses incurred on hospitalization can be claimed only after the patient gets discharged from the hospital or on completion of treatment.
If one has to file a health insurance claim, they must keep all receipts and arrange them in chronological order.
Get the claim form from the health insurance company, prepare copies of the original for the purpose of claim submission, review and dispatch documents and understand the fine print in the policy document.
You should keep not only all receipts, bills and medical reports as part of the hospitalization but also the ones obtained during 30 days prior to and 60 days after hospitalization.
The medical services availed during this period as part of the same treatment, are generally applicable to be reimbursed.
While filing the health insurance claim, all the receipts, bills, discharge summaries, investigation reports, consultation sheets etc. need to be submitted in original and copies. Retain a copy incase the documents are misplaced or lost.
In order to file your health insurance claim, the next step is to get the claim form from the insurance company.
Alternatively, the claim form can be downloaded from the official website of the health insurance company.
After completing the compilation of the claim to be reimbursed, re-check your documents. Verify the documents and see that no document issued during the treatment process is missing.
This is necessary to avoid a claim shortfall. Check whether all the documents are relevant to the treatment for which the health insurance claim is to be submitted.
Ask the health insurance company to which Third Party Administrator the claim documents have to be submitted.
Usually all health insurance claims have to be filed within 7 days of completion of treatment or discharge from the hospital.
Remember that health insurance companies will not honor claims in case the documents are not as per their terms and conditions.
Understand that the entire medical expenses incurred during hospitalization may not be reimbursed to the health insurance policy holder.
Make a note of the deductions or the medical expenses that are not included in the cover. Understand and get a clear picture of the entire process.
This is of utmost importance as such expenses incurred as part of the medical treatment will not be reimbursed to the claimant.
Curated from How To File A Health Insurance Claim